Improving accuracy in diagnosing aortic stenosis severity: An in‐depth analysis of echocardiographic measurement error through literature review and simulation study
Echocardiography, vol. 40, pp. 892–902
Abstract
Abstract Aims The present guidelines advise replacing the aortic valve for individuals with severe aortic stenosis (AS) based on various echocardiographic parameters. Accurate measurements are essential to avoid misclassification and unnecessary interventions. The objective of this study was to evaluate the influence of measurement error on the echocardiographic evaluation of the severity of AS. Methods and results A systematic review was performed to examine whether measurement errors are reported in studies focusing on the prognostic value of peak aortic jet velocity (Vmax), mean pressure gradient (MPG), and effective orifice area (EOA) in asymptomatic patients with AS. Out of the 37 studies reviewed, 17 (46%) acknowledged the existence of measurement errors, but none of them utilized methods to address them. Secondly, the magnitude of potential errors was collected from available literature for use in clinical simulations. Interobserver variability ranged between 0.9% and 8.3% for Vmax and MPG but was higher for EOA (range 7.7%‐12.7%), indicating lower reliability. Assuming a circular left ventricular outflow tract area led to a median underestimation of EOA by 23% compared to planimetry by other modalities. A clinical simulation resulted in the reclassification of 42% of patients, shifting them from a diagnosis of severe AS to moderate AS. Conclusions Measurement errors are underreported in studies on echocardiographic assessment of AS severity. These errors can lead to misclassification and misdiagnosis. Clinicians and scientists should be aware of the implications for accurate clinical decision‐making and assuring research validity.
Authors 8
-
Bart J.J. Velders corresponding Aachen Department of Cardiothoracic Surgery Leiden University Medical Center Leiden The Netherlands Department of Cardiothoracic Surgery
Leiden University Medical Center
Affiliation as printed
Department of Cardiothoracic Surgery Leiden University Medical Center Leiden The Netherlands
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
-
Rolf H. H. Groenwold Aachen Department of Biomedical Data Science Leiden University Medical Center Leiden The Netherlands Department of Clinical Epidemiology Leiden University Medical Center Leiden The Netherlands Department of Biomedical Data Science Department of Clinical Epidemiology
Leiden University Medical Center
Affiliation as printed
Department of Biomedical Data Science Leiden University Medical Center Leiden The Netherlands
Department of Clinical Epidemiology Leiden University Medical Center Leiden The Netherlands
Department of Biomedical Data Science, Leiden University Medical Center, Leiden, The Netherlands
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
-
Nina Ajmone Marsan Aachen Department of Cardiology Leiden University Medical Center Leiden The Netherlands Department of Cardiology, Leiden University Medical Center
Leiden University Medical Center
Affiliation as printed
Department of Cardiology Leiden University Medical Center Leiden The Netherlands
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
-
Affiliation as printed
Global Clinical Operations Coronary and Structural Heart Medtronic Maastricht The Netherlands
Global Clinical Operations, Coronary and Structural Heart, Medtronic, Maastricht, The Netherlands
-
Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers
Affiliation as printed
Department of Cardiothoracic Surgery Amsterdam UMC Location AMC Amsterdam The Netherlands
Department of Cardiothoracic Surgery, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
-
Jerry Braun Aachen Department of Cardiothoracic Surgery Leiden University Medical Center Leiden The Netherlands Department of Cardiothoracic Surgery
Leiden University Medical Center
Affiliation as printed
Department of Cardiothoracic Surgery Leiden University Medical Center Leiden The Netherlands
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
-
Robert J.M. Klautz Aachen Department of Cardiothoracic Surgery Leiden University Medical Center Leiden The Netherlands Department of Cardiothoracic Surgery
Leiden University Medical Center
Affiliation as printed
Department of Cardiothoracic Surgery Leiden University Medical Center Leiden The Netherlands
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
-
Michiel D. Vriesendorp Aachen Department of Cardiothoracic Surgery Leiden University Medical Center Leiden The Netherlands Department of Cardiothoracic Surgery
Leiden University Medical Center
Affiliation as printed
Department of Cardiothoracic Surgery Leiden University Medical Center Leiden The Netherlands
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
Cited by 10 stored of 10
10 results
No patents citing this paper on Lens.org (checked 2026-10-11).